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COVID-19 Procedures

Termination of Services/ Lay-off Certificate

PERSONAL DETAILS OF EMPLOYEE
National Insurance Number*
National Registration Number*
Name
First Middle Last
Address
District
Parish
Zip/Postal Code
Tel. No.
Cell No.
Email
EMPLOYER DETAILS
Name of Employer
Employer's Registration No.*
Address
District
Parish
Zip/Postal Code
Tel. No.
Fax No.
EMPLOYMENT DETAILS
Occupation
Position within Organisation
Date Employment Commenced
Date Format: DD slash MM slash YYYY
Date of Termination
Date Format: DD slash MM slash YYYY
Last date at work
Date Format: DD slash MM slash YYYY
Last date for which employee will be paid
Date Format: DD slash MM slash YYYY
State reason for unemployment
Was employee Laid off?
- Yes
- No
Date of Lay off
Date Format: DD slash MM slash YYYY
Expected date of re-employment
Date Format: DD slash MM slash YYYY
OTHER DETAILS
Is the employee receiving or entitled to pension from employer?
- Yes
- No
Start date of pension
Date Format: DD slash MM slash YYYY
Was holiday pay given to employee who was laid off?
- Yes
- No
From
Date Format: DD slash MM slash YYYY
To
Date Format: DD slash MM slash YYYY
Amount of holiday pay?
Was the employee dismissed because of his/her own misconduct?
- Yes
- No
Explain
Did the employee voluntarily leave your employment?
- Yes
- No
Has the employee become unemployed because of stoppage of work attributable to a labour dispute at your workplace?
- Yes
- No
Is/Was the employee participating in a strike?
- Yes
- No
Any other relevant details?
I declare that the information given on this form is true to the best of my knowledge and belief.
Signature of Employer*
Date signed*
Date Format: DD slash MM slash YYYY
WARNING: ANY PERSON WHO MAKES A FALSE STATEMENT IS PUNISHABLE BY A FINE OR TERM OF IMPRISONMENT OR BOTH.

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467-4NIS (4647)
customer.service@bginis.gov.bb

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